ORIENTAL INSURANCE CO LTD Vs. INSURANCE OMBUDSMAN

JUDGEMENT

(1.) - Challenge put forth in the present writ petition filed under Article 226/227 of the Constitution of India is to an order dated 8. 7. 2003 passed by the insurance Ombudsman, respondent No. 1, whereby, the claim put forth by respondent no. 2 has been allowed and the petitioner was directed to settle the claim for a sum insured, i. e. , Rs. 80,000 along with interest at the rate of 9 per cent per annum from 1. 4. 1994 till the date of full and final payment.

(2.) THE facts in nutshell are that Archana chourasiya, the respondent No. 2, filed a complaint to the Insurance Ombudsman, respondent No. 1, on 29. 7. 2002, seeking the claim of Rs. 80,000 in lieu of death of her husband Ashok Chourasiya, who was working as Assistant Grade II in the Office of Executive Engineer, M. P. State Electricity Board (for short referred to as 'the mpseb'), City Division (North), Bhopal. The said Ashok Chourasiya met with an accidental death on 24. 11. 1993. The claim put forth by Archana Chourasiya, respondent No. 2, was on the anvil that MPSEB, respondent No. 3 and the petitioner Oriental Insurance Co. Ltd. had entered into a contract of insurance on 18. 11. 1986 for implementation of Group Personal Accident Policy in accordance whereof amount of Rs. 80,000 (rupees eighty thousand) was to be paid to the family members of class iii and class IV employees, in the event of death of such employee.

(3.) THE Ombudsman while entertaining the claim put forth by respondent No. 2, issued notices to the petitioner in response whereof claim put forth by respondent No. 2 was denied. However, no notices appear to have been issued to MPSEB. The Ombudsman, thereafter, by impugned order dated 8. 7. 2003 directed the petitioner Oriental Insurance Co. Ltd. to settle the claim of respondent No. 2. The said claim of respondent No. 2 was allowed on the basis of finding that the policy was first issued on 18. 11. 1986 and was continuously renewed with insurer every year on expiry till the year 1995 when renewal order was passed to other insurer. It was also noted by the ombudsman that one Ashok Chourasiya a class III employee working as Assistant grade II in City Division (North), MPSEB, bhopal, died in an accident on 25. 11. 1995. An intimation was given to the insurer and the claim was not allowed and despite the repeated reminders no heed was paid by petitioner Oriental Insurance Co. Ltd. It is on the anvil of these facts, Ombudsman directed to settle the insured claim as noted above.